When her climbing coach takes an interest in her, his attention is more complicated than she anticipated. She yearns to be noticed, even as she wants to disappear. As a teenager, Sam begins to doubt herself. The correct choice of surgical technique requires an understanding of the anatomical substrate of SAM. Hanging from the highest limbs of the tallest trees, scaling the side of a building, Sam feels free. A stepwise approach is advocated consisting of medical therapy, followed by aggressive volume loading and beta-adrenoceptor blockade. This article describes what the clinician needs to know about SAM ranging from pathophysiological mechanisms and imaging modalities to conservative (medical) and surgical approaches and their respective outcomes. Cardiac magnetic resonance imaging has a special role in understanding the dynamic nature of SAM, especially in anatomically atypical hearts (including HCM). Echocardiography (2D, 3D and stress) has a central diagnostic role as the application of echocardiographic SAM predictors allows the incorporation of prevention techniques during surgery and post-operative SAM assessment. The SAM can occur in the normal population, but is typically observed in patients with HCM or following MV repair.

The mechanisms of SAM are complex and depend on the functional status of the ventricle. The SAM can result in severe left ventricular outflow tract obstruction and/or mitral regurgitation and is associated with an up to 20% risk of sudden death (which is substantially lower in hypertrophic cardiomyopathy (HCM)). Systolic anterior motion (SAM) of the mitral valve (MV) can be a life-threatening condition.

Sam & dave dig a hole